P02.14: Continuous vacuum depression vs. syringe amnioreduction for polyhydramnios: a prospective randomised study

Objectives: To prospectively compare the efficacy and tolerance of two techniques of amniodrainage used in the treatment of symptomatic polyhydramnios: syringe aspiration (SA) and continuous vacuum depression (VD). Patients and Methods: Prospective randomised study, performed over 37 months. The main comparison criterion was maternal pain, blindly assessed by a midwife using a visual quantitative scale (EVA from 0 to 100 points). Comparison also included: duration and volume of fluid drained, need to stop the procedure because of maternal pain, uterine activity after drainage, foetal tolerance controlled with CTG (FHR blindly analysed by 2 obstetricians) and absence of placenta abruption controlled by histological examination of the placenta. We calculated that 35 patients would be necessary in each group to show a 20 points difference on the EVA with a power of 80% (alpha: 0.05). Results: 80 amnioreductions were performed in 53 patients. The two groups were comparable for the tested variables (age, parity, term, deepest pool and amniotic fluid index before drainage, uterine contractility, tocolysis) as well as for the aetiology of polyhydramnios. Drained volume was significantly higher in the VD group (2540 ml +/− 860 versus 1250 ml +/− 530; p < 0.01) and the drainage duration significantly shorter (12 mn +/− 10 versus 38 mn +/− 25; p < 0.01). Maternal pain was significantly lower in the VD group compared to the SA group (25 +/− 12 vs. 55 +/− 22; p < 0.01). No significant difference was noted in uterine contractility or FHR abnormalities between the two groups and they were no occurrence of clinical placental abruption. In four cases, histological analysis of the placentas revealed the presence of old placental infarctions (three in the SA group and one in the VD group). Conclusion: Continuous vacuum depression appears to be faster and has a better maternal tolerance than syringe aspiration.